NC Presentation made in the Second Consultation on Macro-economics 1 and Health WHO, Geneva, 28-3 October 23
Good Health Leads to Economic Development Good Health and Longitivity improves productivity Improves Disposable Income Motivates for Better Education & Training Motivates Technological Advance Helps in Efficient Division Labor Promotes Well Functioning Markets Leads to better Good Governance 2
Myanmar DPR Korea (in %) 6 5 4 3 2 1 Salient Features SEAR 1 9 8 7 6 5 4 3 2 1 DPR Korea Banglade sh Myanmar (in %) 1 9 8 7 6 5 4 3 2 1 Population Growth Total Fertility rate (births per woman) Population with access to safe drinking water Population with access to adequate sanitation (%) DPR Korea Myanmar (in % ) 1 9 8 7 6 5 4 3 2 1 DPR Korea Myanmar (in %) Live Births Attended by trained personnel Adult literacy Rate Life Expectancy at Birth 3
Millennium Development Goals Unparalleled importance to Health 8 Goals, 18 Targets, and 48 Indicators Health related - 3 Goals, 8 Targets and 18 Indicators - Centrality Health in MDGs Health Goals by 215 Reduction U-5 Mortality by two-thirds Reduction MMR by three quarters Reversing the spread diseases, especially HIV/AIDS and malaria Mixed Results No reversals in MDG indicators in SEAR while last year was many reversals globally Good performance by, and in reducing U-5 mortality rates. Moderate performance in DPR Korea, Malaysia and. Myanmar's progress in U5 has been not satisfactory excelled in preventing the spread HIV/AIDS by more than 8 % since early 9 s s achievement on life expectancy front is especially commendable Sub-national level, inter-group disparities and gender inequalities are all over, 4
GDP Per Capita (PPP) and Human Development Index (in PPP US$) 7 6 5 4 3 2 1 GDP Per Capita Positive Association Myanmar HDI Value Higher the GDP higher is the HDI value - exceptions are and 1..9.8.7.6.5.4.3.2.1. (Values) (%) 1 9 8 7 6 5 4 3 2 1 Poverty and Health Expenditure Health expenditure are low amongst countries having high incidence poverty such as, and and vice-versa, such as in and Sri Lanka 5 Percent below $1 a day Percent below $2 a day Public Health Expenditure Inverse Association 1 9 8 7 6 5 4 3 2 1 (in %)
Multi-Sectoral Linkages leading to Health and Economic Growth Economic Growth Delivery and Governance Health & Longitively Health Economic Growth Income Environment Education Agriculture Infrastructure Investment Savings Water & Sanitation Pharmaceutical Industry Food and Nutrition 6
(in %) 1 9 8 7 6 5 4 3 2 1 Malnutrition Intergenerational Drag Myanmar Pregnant Women Children Children (U5) Underweight Nutrition and health women and children are neglected areas in all countries excepting neglected Levels malnutrition in the SEAR is higher than Sub-Saharan Africa normally categorized as chronic food deficit countries The levels anemia amongst the pregnant women in the SEAR is highest in the world Women deficient in iron intake and iron supplemented diet Main Causes Lower duration breast-feeding Poor weaning methods Low calorie and protein intakes High levels vitamin A & Iodine deficiency 7
Reduction in DALYs High Direct and Indirect Costs ill-health Increase in medical expenses at the cost essential expenditures such as on food and education Loss personal income and assets leading to loss national income Loss valuable work-hours due to disability and loss life-years due to death Increase workload on other family members so as to compensate for reduced household income Increase in school drop-out so as to join labour market Produce conditions to increase fertility so as to ensure old age security Enhanced pressure on public funds and government allocations under stress Reduced tax mobilization due to depletion tax payers and reduced economic activity Shrinking National Income 8
Govt. Health Spending (% GDP) Structure Health Spending Counties 196 1998 SEAR.5.9.8 1.6.2 1.3 2. 1.4.7.9 Low Public Expenditures on Health Reduction in Govt. Expenditure results in a squeeze on health spending Relaxation price controls increases spending on non-health services (in %) 12 1 8 6 4 2 DPR Korea Myanmar Total Expenditure on Health (THE) % GDP GHE % General Govt. Expenditure (GGE) Private Expenditure on Health (PHE) % THE 1 9 8 7 6 5 4 3 2 1 Negative Effects: Economically worse section the population Substantial differences in the structure expenditure and sources money 9
Public and Private Share in Health Expenditure 4 35 35 3 (in $) 3 25 2 15 1 5 DPR Korea Government Private (in $) 25 2 15 1 5 DPR Korea Tax Funded External Higher the GDP-Population ratio, higher is the per capita government expenditure External aid is close to nil except meager amounts in, and 1
hy Essential Nature Diseases in SEAR require mass investments that can be done only by public sector. Multi-sectoral approach can be efficiently implemented through governmental initiatives. Equity and poverty focus can be an objective only the public bodies. Investment in newly emerging diseases such as HIV/AIDs and chronic disease the poor such as the TB, malaria, cholera and gastroenteritis needs determined government initiatives. Imperative Public Services Inadequate Inadequate Poor Poor quality quality Inaccessible Inaccessible Inefficient Inefficient Poor Poor referral referral Necessary Steps/Care Improve Improve physical physical infrastructure infrastructure Enhance Enhance quality quality and and skills skills workforce workforce Strengthen Strengthen outreach outreach activities activities to to rural rural and and inaccessible inaccessible areas areas Introduce Introduce careful careful cost-recovery cost-recovery mechanisms mechanisms while while protecting protecting the the interest interest the the poor poor Public-Private Partnership Essential Why Essential Insufficient public investment in Health in SEAR Resource constraints in social and health sector delivery, Limited resources to invest in newly emerging diseases such as HIV/AIDS and chronic disease the poor such as the TB, malaria, cholera and gastroenteritis. Innovative Compacts Global public-private partnership Partnership with commercial sector in both production and distribution Compact between multiple healthcare providers Rich and Poor Country Compact Improve Quality Government can contract or purchase services to/from private sources for identified poor patients. Govt. needs to dedicate funds and programs such as the MCH, reproductive health and family planning services. Private Services Expensive Expensive Over-prescribe Over-prescribe Unregulated Unregulated Inefficient Inefficient Over-treat Over-treat illness3 illness3 Necessary Steps/Care Compact Compact with with strict strict regulation regulation pressional pressional ethics ethics No No contradiction contradiction in in nature nature association association Private Private health health providers providers should should be be more more accountable accountable and and responsible responsible There There should should also als be be healthy healthy competitions competitions among among the the privat priva health health providers providers 11
Estimated Domestic Resources (Per Capita Expenditure in US $) Estimated External Resources (Per year) 3 4 (in $) 25 2 15 1 5 PCE () PCE (7) PCE (15) (in billion US$) 35 3 25 2 15 1 5 1998 22 Years 27 215 Increase donor-funding flows with fundamental reforms (priority subsectors Health) The current allocations are for too low. By 215, would not change remarkably except in and Improve the efficiency resources Economic Economic gains gains would would be be US$ US$ 36 36 billion billion per year during 215-22 12
Relevance WTO Linked Reforms Multilateral Negotiations Transparent compared with bilateral ten exploitative trade TRIPs / Patents regime progressive in the long run. Developing country safeguards and protection to the poor should be negotiated Global Trade beneficial to developing countries - Share Exports have increased compared to Imports since last 1 years 13
Strategic Vision Better Health essential to improve quality Labour force leading to efficiency financial and physical investments There is pro-rich bias in policy due to Selectivity Bias. Also reduce Urban Bias in Healthcare Delivery Multi-sectoral interactive links health with environment, water, sanitation, public hygiene, and food and nutrition is important. Decentralization Health Services Improves Efficiency Promote Tripartite Health Insurance Device Community Health Financing 14
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